Evo Terra (Host): This is The Peds Pod by Le Bonheur Children's Hospital. I'm Evo Terra. And with me are doctors Jason Frischer, Surgeon-in-Chief and Division Chief of Pediatric Surgery, and Dr. Mark Corkins, Division Chief on Pediatric Gastroenterology, both at Le Bonheur Children's Hospital. Our topic, inflammatory bowel disease And it's impact on pediatric care. Thanks for joining me, Dr. Frischer and Dr. Corkins.

Jason Frischer, MD: Excited to be here.

Mark Corkins, MD: Hey, always a chance to talk and teach is a wonderful opportunity for a doctor.

Host: Well, let's get into this. So, I'll start with the basics. What is inflammatory bowel disease? What causes it, and what are the symptoms like specifically in kids? Dr. Corkins, I'll start with you.

Mark Corkins, MD: Well, so inflammatory bowel disease is an what we call an autoimmune disease. You know, we have an immune system and it's designed to ward off all sorts of bacteria and viruses and that kind of thing. But sometimes that immune system gets confused and will attack our own tissues.

And there are a lot of diseases. There's rheumatoid arthritis. And there's thyroiditis and diabetes. The juvenile diabetes is an autoimmune disease. So, inflammatory bowel disease is an autoimmune disease where own immune attacks your own GI tract, okay? Now, the problem is the GI tract's pretty long. So, it can attack anywhere from the mouth to the anus in some of the diseases. So, the symptoms are very variable. I've seen everything from a child who presented with mouth sores that just wouldn't heal to profound diarrhea, bloody stools. So, the symptoms can mimic a lot of different things.

There are basically two main types of inflammatory bowel disease. There's Crohn's, which is again the one that tends to be anywhere from the mouth to the anus. And there's ulcerative colitis, which tends to be only in the colon. There's a few variants. And what's interesting too is some people talk about indeterminate inflammatory bowel disease where you can't quite tell which one it is. And that usually takes a little time. It'll kind of sort of tell you, which one it is over time.

Host: Got it. Okay. Well, what causes this IBD? You said it's an autoimmune disease. So, is that just someone's body is what causes it?

Mark Corkins, MD: At least right now, that's what we understand. There are some pretty well done studies that show there's some genes associated with some of these diseases. And it's how the immune system works, which sort of makes sense. So, it does run in families. And if you have inflammatory bowel disease, there's a higher risk, your child will have an inflammatory bowel disease.

But the understanding's not a hundred percent complete. We don't completely understand it. We know a lot more than we used to. Some of these genes are coming out. There's a gene that is how antigens are presented to the inflammatory system, you know, our immune system, and that's one of the genes that's off. And so, maybe it's how some of these naturally occurring body proteins are presented. But again, all this is very much at the theory level right now.

Jason Frischer, MD: Just to add on to what Dr. Corkins is saying, it is interesting how medicine develops. The treatments for inflammatory bowel disease treat what Dr. Corgans is saying. Most of the treatments treat your immune system. And a few of them treat the bacteria. But primarily, all these new medications that are coming out, every week you see a new commercial are primarily in one way or another calming down your immune system, which is acting inappropriately.

Host: Got it. Good information from both of you. So if I were to have a child, then I was suspecting something that might be related to IBD, when should I be seeking out a specialist?

Mark Corkins, MD: Well, that's a great question. It can be very subtle. Now if the symptoms are very obvious, I hope that your primary pediatrician or primary care doc is going to look at you and say, "You need to see a GI doctor right away." Now, some of the more subtle ones, like I said, I've seen a kid who had mouth sores that just wouldn't heal. And the dentist said, there's something odd here, and sent the child to see me. And the kid did turn out to have Crohn's. And it was a little bit of some inflammation, one area of the bowel. But the biopsies were characteristic of it. So, it can mimic a lot of different things. But if there's a suspicion, the place to start is probably with your primary care. A lot of times, they can kind of do a little bit of some tests upfront to kind of give you some hints and some clues if this is the way you need to go or not.

Host: Now, Dr. Frischer, a moment ago you were talking about some treatments. And those treatments either impact the immune system, which is overzealous or attacking some bacterial. Dr. Corkins, are those accurate? What are other treatments that are available for children specifically with IBD?

Mark Corkins, MD: There's a whole bunch of treatments. But as Dr. Frischer said, a lot of them have to do with changing how the immune system works. Now, it's interesting in that these new treatments are very directed at some very specific pathways. Some of the very first-line drugs we use are ones against something called tumor necrosis factor alpha, which is part of the inflammatory cascade.

And it's interesting in that now people think when you start talking about the immune system, they think it's all-or-nothing. Now, if you have a transplant and you don't want to reject it, you turn the immune system pretty much all the way off. With these drugs, it's more directed. And we talk about immune modulation as opposed to immunosuppression, and we're turning it down, but not off, which is a very subtle difference, but actually very significant. The people who have a transplant or something around some of the very strong immunosuppression drugs, they have to be extremely careful about where they go and what they do.

Now, the inflammatory bowel disease patients on some of these drugs, they have to be careful. But on the other hand, we talk about remission. And we haven't gotten to that part of the discussion yet. But we want them to live as normal a life as possible. So, we want them to go to school. We want them to work if they want to work, while they're in school. And then when they're done with school, get a job and have a normal life.

Host: Be productive members of society. Sure, sure. Yeah. Yeah. But I know at some point in time—we have a surgeon here, Dr. Frischer. So, I want to get your opinion of this one. You know, how do you figure out when it's time? And I know that's a conversation obviously, between the surgeon, between primary care, between the gastroenterologist. How does it work? How do you figure out when a child needs surgery?

Jason Frischer, MD: It starts with communication. You want to be part of a team that communicates with each other and are comfortable with each other. And they always say medicine is not a science, it's an art. Well, it's an art when you communicate and individualize the patient's care. So, surgery does not cure inflammatory bowel disease. That is very important to understand, both for Crohn's disease and even, for the most part, ulcerative colitis. Now, ulcerative colitis is a little different And we could get into the nuances of the different surgeries, because there are different surgical procedures for both. But long-term, you need care from your gastroenterologist, whether you have the surgery or not.

Surgery is indicated for a few really hardcore reasons or non-negotiables. And then, the more difficult question is, "When is it going to affect your quality of life and make your quality of life better?" And so, there are some indications for surgery that are a must. Bleeding, bad infections, surgical emergencies where it might be a perforation or a hole in the intestine. Those are emergency surgeries. They're rare, few and far between, but easy. It's more of a conversation between the gastroenterologist, the surgeon, the patient and their family to come up with what plan is right for the patient at that time.

And so, some indications, being on steroids short term is okay. It might make you feel better and get you over that hump that you need to get on a new medication and get you to your next stage of treatment. But if you're on steroids for a long period of time, that is not healthy for you. It's not healthy for long-term bone growth and other reasons. And maybe surgery might overcome that obstacle where the medicines just aren't working. Growth and development during those growth spurt years, if you're on a lot of these medications and you're not growing, because the disease might be subdued, but not completely in remission. And it might be hindering growth and development. One might consider surgical interventions at that time. And that's why it's a pendulum, it's a spectrum. And it really is important to have your care with a team that communicates and works together and is comfortable with each other doing their part of the total care that your patient needs.

Mark Corkins, MD: And I will add there, you know, he said that surgery's not a cure. Even our medicines aren't a cure. remission is not a cure of disease. There is no cure right now as of April 2026. There's no cure for inflammatory bowel disease. We talk about remission, like you take your medicines, you don't even know you have the disease, but it's not a cure.

Jason Frischer, MD: I think, and it is probably beyond this talk. I draw a Venn diagram when you asked that question earlier, what causes Crohn's disease. And just like Dr. Corkins mentioned, I have genetics, I have the environment and your immune system, the environment's, the bacteria, and a few other things. And most of the treatment, like I mentioned earlier, is on the immune system.

I think the cure is probably going to come when we figure out the genetics of it. But I trained at Mount Sinai where—just as an aside that's not part of this—I trained at Mount Sinai where Dr. Crohn was from. And I remember the day Remicade, this first anti TNF alpha drug, we did the initial clinical trial and it was amazing. It was back in 1998, '99. And it was really wild when that paper came out. So, something's going to

. I mean, Dr. Corkins, I don't even know how many drugs treat Crohn's disease, but it used to be some drugs that you don't even use anymore, like 6-MP and some of those older agents. And then, Remicade came out. And now, I can't name all the biologics, these targeted therapies that you're mentioning.

Host: And I know from just my viewpoint as a lay person here, it seems like there's a new biologic or something else coming out every other day. So, there's a big boon going on. So, I know the future is going to even look better. But Dr. Frischer, I want to go back to you and I'm not going to ask you to describe the surgical procedure, because I'm sure it's varied depending on where it is. But let's talk about recovery. I think a lot of parents might be concerned if they send their child in for surgery, that there's a recovery period. And of course, there always is. So, can you tell us a little bit about that?

Jason Frischer, MD: And it depends on the disease, and especially like Dr. Corkins said earlier, Crohn's disease can affect just small areas like the mouth and anus, and you might have local procedures to help in those regions. But primarily, these diseases, the inflammatory bowel disease affect the bowel.

And so when you have surgical procedures on your bowel, they have recovery periods. Now, when I started treating these patients back in the '90s and early 2000s, we just started dabbling in laparoscopic surgery or minimally invasive surgery. And so, patients would get large incisions and have really long recovery times. Now, it's almost standard of care for most patients to be able to undergo these procedures, either laparoscopically and/or robotically, have a few small scars the size of their pinkies on their abdomen, which has enhanced the recovery period significantly. So in the hospital for a few days, eating and drinking after a couple of days and really recovering back-to-school within a week or so and back to almost all contact sports and normal activities within a month. So, yes, big surgeries. But the evolution of the surgical procedures has come a long way in the last couple decades, making the recovery significantly better than it was in the past.

Host: Yeah. That's great. So, let's talk about some results. What have you seen in your patients who have had surgery for IBD?

Jason Frischer, MD: This goes to the why you're having the surgery to begin with. Often I think these patients have tried a number of medications now and just the medicines have been refractory to really helping the patient, whether they still have pain or bleeding or having multiple bowel movements, growth restriction?

So, I would say the majority of patients after surgery, and there are studies in the literature, I've participated in these studies and written the papers. Patients are highly satisfied and really regain a stronger or better quality of life after these surgeries. But like we said before, these surgeries are not curative. And, so you really want to try to medical treatment first.

Because it's always better and safer if one of these medications might be that right treatment to put you in remission and let you go on with a great quality of life. But when that's not happening, the surgery is certainly an option.

And then, the outcomes usually are good, because you've gotten to a point where we remove the acute disease that's causing those symptoms that are really bothering you,

such as a stricture or a narrowing where you're not able to eat or drink everything as you want, where you eat or drink, and it causes pain. And so, removing that segment of intestine that is causing the problem usually relieves the symptoms pretty remarkably and pretty quickly.

Mark Corkins, MD: And now, I would be remiss if I didn't comment too that the surgeons have gotten very creative too. Some of our kids that required a colectomy, they create a pouch for them so they have some better quality of life, because they don't have to stool all the time because they don't have a colon anymore. And you left that out. And I'm reminding you, and I'm not the surgeon.

Jason Frischer, MD: Yes, thank you. It's actually one of my favorite surgeries. And I was more talking towards Crohn's disease. Ulcerative colitis gets a different surgery. It's called a colectomy and a J-pouch creation. It's a technically a little bit more sophisticated procedure. Not all surgeons perform this surgery, but the outcomes for these patients who have colitis, ulcerative colitis particularly, when they've maximized their medical therapy and are still not getting that quality of life they really are desiring, the studies have shown that their quality of life gets significantly better after having these surgeries.

And Dr. Corkins, I just saw one of your patients on Monday with this, who I was very appreciative for seeing and a great family, and looking forward to helping take care of them with you.

Host: Always good to see the success stories for sure. I'll let each of you answer this question. Advice, encouragement. What have you got for parents who have a child that is currently suffering from IBD?

Mark Corkins, MD: I think the most important thing is, number one, we talk about remission. We try to find a medicines or surgery or some combination of therapies to get you into remission. And your life is normal as long as you take your medicines. There are all sorts of people who have inflammatory bowel disease. There was an Olympic silver medalist in swimming who had inflammatory bowel disease. Rolf Benirschke, who was a kicker for the San Diego Chargers back in the day, Don Coryell era, he had Crohn's disease. So literally, we talk about remission. And as we were talking about already all these medicines and the genetic studies, it's kind of exciting because where we're at and where we're going, it looks like there's a very bright future. The treatments get better. And I say we don't have a cure as of right now. Who knows in 10 years, maybe we will.

Jason Frischer, MD: Yeah. I'll add to that. I think advice to the families and patients, find a team you're comfortable with that you know works together that has your child's or your best interest. And that has experience. This is a complicated disease, as you heard throughout this podcast. There are no simple answers. We don't have all the answers. So, having a team that's going to work with you, and that works together, I think, is one key.

Two, like Dr. Corkins said, there are a number of very successful people who have inflammatory bowel disease. There's NBA players. I participated in the J-pouch creation of an NBA player. He had a stoma. We closed his stoma, played in the NBA during all of this. So, you could do anything. So, really get the right treatment. When you're not feeling well, seek treatment. When you're doing great, do great things. It's all possible.

Host: Great advice, Dr. Frischer, Dr. Corkins. Thanks both of you so much for being with me today.

Jason Frischer, MD: Pleasure to be here.

Host: And once again, that was Dr. Jason Frischer and Dr. Mark Corkins. To learn more about options for children with inflammatory bowel disease, visit lebonheur.org. That's L-E-B-O-N-H-E-U-R.org. If you enjoyed this episode, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm Evo Terra. And this has been The Peds Pod by Le Bonheur Children's Hospital. Thanks for listening.